Face-off?
No, I'm not talking about the movie with Nicolas Cage and John Travolta, but it is not far off. In the movie the bad guy has his face removed and replaced with that of his enemy, who is an FBI agent. It has its moments, but to pull it off requires a bit of suspension of disbelief and at least a little acting. Obviously the special effect is that they appear to have their faces removed surgically and replaced upon the other person. And of course it is all accomplished in a clandestine temporary surgical suite. It was enough to make me think that I could do it myself in my apartment, if only I had a good headlamp and some suction.
What I am wondering about is the long-term impact of facial transplantation. Normally I don't want to blog about being a doctor all that much, but my brother wanted to know what I thought about it. Hopefully this won't go on too long, but there area a few things to consider.
When I think of facial transplantation, the first thing I wonder about is the recipient. Of course the donor better be donating other organs as well, because it just wouldn't do to donate one's face and then just walk around without one. That's just gross. The person receiving the facial transplant would have to be someone who had sustained a serious disfiguring injury. Burns, animal mawlings, and other violent injuries that resulted in loss of large amounts of skin would be considered. Currently these poor people are subjected to numerous operations to attempt to reconstruct a face from the wreckage, and it is usually nothing short of miraculous to be able to do that much. Burns are the worst due to the sheer magnitude of injury that the skin sustains. It often appears as though the skin has been melted like wax and stirred up, no longer even close to normal appearance. These people must endure not only the pain of the injuries, the recovery, and the surgeries, they also must endure the stares, the teasing by the insensitive, and the cries of children who don't understand and are therefore scared. The psychological impact of losing one's face often changes who that person is; the injury is more than skin-deep, it scars the identity and changes personalities.
In the recent transplantation a woman had been mawled by her own dog, apparently after a failed suicide attempt, and the donor had more successfully attempted suicide. The whole face was not needed, but the recipient was given skin for the chin, nose, and a bit more. Hopefully the result will be successful, but what happens afterwards?
Each person has a unique facial structure such that a transplantation would have to conform to it differently than it did on the donor's face originally. This would allow the recipient to at least maintain some features, but the end result would be a hybridization of the two people, where the person would resemble the donor. This brings up more issues of identity for the recipient. Suppose he had come to terms with his injuries and appearance but now is given an opportunity to gain a new face, but not one of his own choosing- in fact it may not even be an appealing face, but if it is a match, should not he take the chance? That is a tough question. I think that I would likely take the new mug if my own was so damaged, but it would probably be tough to get used to seeing another's face in the mirror. Especially a dead guy's face. At least with a heart transplant, there is some anonymity, and most of us don't think much about what the heart is doing very much, so to have a transplanted heart would only cause most of us to thank God for a new day and for that gift. But a new face? Hardly necessary to sustain the recipient's life, but life-changing it could be. I just hope I never have that choice to make.
What I am wondering about is the long-term impact of facial transplantation. Normally I don't want to blog about being a doctor all that much, but my brother wanted to know what I thought about it. Hopefully this won't go on too long, but there area a few things to consider.
When I think of facial transplantation, the first thing I wonder about is the recipient. Of course the donor better be donating other organs as well, because it just wouldn't do to donate one's face and then just walk around without one. That's just gross. The person receiving the facial transplant would have to be someone who had sustained a serious disfiguring injury. Burns, animal mawlings, and other violent injuries that resulted in loss of large amounts of skin would be considered. Currently these poor people are subjected to numerous operations to attempt to reconstruct a face from the wreckage, and it is usually nothing short of miraculous to be able to do that much. Burns are the worst due to the sheer magnitude of injury that the skin sustains. It often appears as though the skin has been melted like wax and stirred up, no longer even close to normal appearance. These people must endure not only the pain of the injuries, the recovery, and the surgeries, they also must endure the stares, the teasing by the insensitive, and the cries of children who don't understand and are therefore scared. The psychological impact of losing one's face often changes who that person is; the injury is more than skin-deep, it scars the identity and changes personalities.
In the recent transplantation a woman had been mawled by her own dog, apparently after a failed suicide attempt, and the donor had more successfully attempted suicide. The whole face was not needed, but the recipient was given skin for the chin, nose, and a bit more. Hopefully the result will be successful, but what happens afterwards?
Each person has a unique facial structure such that a transplantation would have to conform to it differently than it did on the donor's face originally. This would allow the recipient to at least maintain some features, but the end result would be a hybridization of the two people, where the person would resemble the donor. This brings up more issues of identity for the recipient. Suppose he had come to terms with his injuries and appearance but now is given an opportunity to gain a new face, but not one of his own choosing- in fact it may not even be an appealing face, but if it is a match, should not he take the chance? That is a tough question. I think that I would likely take the new mug if my own was so damaged, but it would probably be tough to get used to seeing another's face in the mirror. Especially a dead guy's face. At least with a heart transplant, there is some anonymity, and most of us don't think much about what the heart is doing very much, so to have a transplanted heart would only cause most of us to thank God for a new day and for that gift. But a new face? Hardly necessary to sustain the recipient's life, but life-changing it could be. I just hope I never have that choice to make.
posted by The Doctor at vendredi, décembre 16, 2005
5 Comments:
I just can't imagine how they can get blood supply and nerve connections to
"take" in a surgery of this magnitude.
I would hate to be a participant in any way. Donor would be worst, I guess, but recipient is no fun, either, and even medical professionals must be totally spent after that many hours of tedium.
I wonder about the nerves especially, because if one cannot feel something, it seems so much more foreign, which is why people with nerve loss to a limb (from injury or stroke or whatever cause) often neglect the affected part, even when it is injured.
What about the survivors of the donor? Can you imagine bumping into the new guy at McDonald's or something--surrounded by salt, fat, and ground beef?
I wonder if families would hesitate to agree to facial donations? It would just be so strange. I hear you about the bones, but still.
You reminded me of a favorite joke. I used to love to say to those discussing Face Off, "Oh yeah, did you hear that was based on a true story?"
You'd be surprised how gullible people can be.
I do remember that. How disgusting. But it wasn't skin--no risk of that thing you mentioned--it was a syringe full of fat tissue, and they just injected it. (Isn't that right? Or maybe I'm thinking of Montel or Maury or who knows.) Oh--and Mrs. Wales, a career OR nurse--has absolutely heard it all. Between the surgeons' stories, the morning radio and the subjects/patients of the operations....
I'm so proud...
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